Recombinant tissue plasminogen activator plus citrate versus citrate alone as catheter lock for tunnelled catheters of haemodialysis

Detalhes bibliográficos
Autor(a) principal: Magriço,Rita
Data de Publicação: 2017
Outros Autores: Santos,José Paulo, Colaço,Susana, Dias,Sara, Ramos,Aura
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692017000200002
Resumo: Introduction: The solution used to fill the lumens of the tunnelled catheters for haemodialysis (lock) influences catheter-related complications, such as inadequate blood flow and dialysis efficacy. It is unknown whether a lock strategy with weekly administration of Recombinant Tissue Plasminogen Activator (rt-PA) and of citrate during the remaining dialysis sessions is associated with better catheter blood flow and increased dialysis dose compared with citrate alone. Methods: We performed a prospective cross-over study in 16 patients to compare weekly administration of 1mg per catheter lumen of rt-PA and citrate 4% in the remaining sessions with citrate 4% administration in all dialysis sessions. Each lock strategy was performed for 24 weeks, separated by a 4-week wash-out period. We performed a random effects model and two paired t-tests (in each intervention group and in each patient) to compare the mean blood flow and single-pool Kt/V (spKt/V) of each dialysis session. Results: In the 8 patients eligible for comparison, blood flow was higher in the rt-PA group (380.73 ± 33.43 mL/min versus 368.86 ±34.86 mL/min; p-value <0.001). The mean increase in the random-effects model after adjustment for time was 13.79 mL/min (95% CI 10.23-17.34 mL/min). There was a high variability between subjects on the difference in blood flow achieved with the two lock strategies (non-significant in 4 subjects; from 8 to 51 mL/min in the remainder). Mean spKt/V value was 1.43 in the rt-PA group and 1.39 in the citrate-alone group. Conclusions: When compared with citrate alone, weekly administration of rt-PA was associated with higher blood flow and spKt/V. The clinical benefit of this intervention is questionable, since the mean increase in blood flow was 13.79 mL/min and in 4 out of 8 patients was not significant. Dose of dialysis achieved the recommended target in both groups
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spelling Recombinant tissue plasminogen activator plus citrate versus citrate alone as catheter lock for tunnelled catheters of haemodialysisBacteraemiaCathetersCitric AcidDialysisPlasminogen ActivatorsThrombosisIntroduction: The solution used to fill the lumens of the tunnelled catheters for haemodialysis (lock) influences catheter-related complications, such as inadequate blood flow and dialysis efficacy. It is unknown whether a lock strategy with weekly administration of Recombinant Tissue Plasminogen Activator (rt-PA) and of citrate during the remaining dialysis sessions is associated with better catheter blood flow and increased dialysis dose compared with citrate alone. Methods: We performed a prospective cross-over study in 16 patients to compare weekly administration of 1mg per catheter lumen of rt-PA and citrate 4% in the remaining sessions with citrate 4% administration in all dialysis sessions. Each lock strategy was performed for 24 weeks, separated by a 4-week wash-out period. We performed a random effects model and two paired t-tests (in each intervention group and in each patient) to compare the mean blood flow and single-pool Kt/V (spKt/V) of each dialysis session. Results: In the 8 patients eligible for comparison, blood flow was higher in the rt-PA group (380.73 ± 33.43 mL/min versus 368.86 ±34.86 mL/min; p-value <0.001). The mean increase in the random-effects model after adjustment for time was 13.79 mL/min (95% CI 10.23-17.34 mL/min). There was a high variability between subjects on the difference in blood flow achieved with the two lock strategies (non-significant in 4 subjects; from 8 to 51 mL/min in the remainder). Mean spKt/V value was 1.43 in the rt-PA group and 1.39 in the citrate-alone group. Conclusions: When compared with citrate alone, weekly administration of rt-PA was associated with higher blood flow and spKt/V. The clinical benefit of this intervention is questionable, since the mean increase in blood flow was 13.79 mL/min and in 4 out of 8 patients was not significant. Dose of dialysis achieved the recommended target in both groupsSociedade Portuguesa de Nefrologia2017-06-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articletext/htmlhttp://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692017000200002Portuguese Journal of Nephrology &amp; Hypertension v.31 n.2 2017reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692017000200002Magriço,RitaSantos,José PauloColaço,SusanaDias,SaraRamos,Aurainfo:eu-repo/semantics/openAccess2024-02-06T17:04:55Zoai:scielo:S0872-01692017000200002Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T02:18:58.271367Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Recombinant tissue plasminogen activator plus citrate versus citrate alone as catheter lock for tunnelled catheters of haemodialysis
title Recombinant tissue plasminogen activator plus citrate versus citrate alone as catheter lock for tunnelled catheters of haemodialysis
spellingShingle Recombinant tissue plasminogen activator plus citrate versus citrate alone as catheter lock for tunnelled catheters of haemodialysis
Magriço,Rita
Bacteraemia
Catheters
Citric Acid
Dialysis
Plasminogen Activators
Thrombosis
title_short Recombinant tissue plasminogen activator plus citrate versus citrate alone as catheter lock for tunnelled catheters of haemodialysis
title_full Recombinant tissue plasminogen activator plus citrate versus citrate alone as catheter lock for tunnelled catheters of haemodialysis
title_fullStr Recombinant tissue plasminogen activator plus citrate versus citrate alone as catheter lock for tunnelled catheters of haemodialysis
title_full_unstemmed Recombinant tissue plasminogen activator plus citrate versus citrate alone as catheter lock for tunnelled catheters of haemodialysis
title_sort Recombinant tissue plasminogen activator plus citrate versus citrate alone as catheter lock for tunnelled catheters of haemodialysis
author Magriço,Rita
author_facet Magriço,Rita
Santos,José Paulo
Colaço,Susana
Dias,Sara
Ramos,Aura
author_role author
author2 Santos,José Paulo
Colaço,Susana
Dias,Sara
Ramos,Aura
author2_role author
author
author
author
dc.contributor.author.fl_str_mv Magriço,Rita
Santos,José Paulo
Colaço,Susana
Dias,Sara
Ramos,Aura
dc.subject.por.fl_str_mv Bacteraemia
Catheters
Citric Acid
Dialysis
Plasminogen Activators
Thrombosis
topic Bacteraemia
Catheters
Citric Acid
Dialysis
Plasminogen Activators
Thrombosis
description Introduction: The solution used to fill the lumens of the tunnelled catheters for haemodialysis (lock) influences catheter-related complications, such as inadequate blood flow and dialysis efficacy. It is unknown whether a lock strategy with weekly administration of Recombinant Tissue Plasminogen Activator (rt-PA) and of citrate during the remaining dialysis sessions is associated with better catheter blood flow and increased dialysis dose compared with citrate alone. Methods: We performed a prospective cross-over study in 16 patients to compare weekly administration of 1mg per catheter lumen of rt-PA and citrate 4% in the remaining sessions with citrate 4% administration in all dialysis sessions. Each lock strategy was performed for 24 weeks, separated by a 4-week wash-out period. We performed a random effects model and two paired t-tests (in each intervention group and in each patient) to compare the mean blood flow and single-pool Kt/V (spKt/V) of each dialysis session. Results: In the 8 patients eligible for comparison, blood flow was higher in the rt-PA group (380.73 ± 33.43 mL/min versus 368.86 ±34.86 mL/min; p-value <0.001). The mean increase in the random-effects model after adjustment for time was 13.79 mL/min (95% CI 10.23-17.34 mL/min). There was a high variability between subjects on the difference in blood flow achieved with the two lock strategies (non-significant in 4 subjects; from 8 to 51 mL/min in the remainder). Mean spKt/V value was 1.43 in the rt-PA group and 1.39 in the citrate-alone group. Conclusions: When compared with citrate alone, weekly administration of rt-PA was associated with higher blood flow and spKt/V. The clinical benefit of this intervention is questionable, since the mean increase in blood flow was 13.79 mL/min and in 4 out of 8 patients was not significant. Dose of dialysis achieved the recommended target in both groups
publishDate 2017
dc.date.none.fl_str_mv 2017-06-01
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dc.publisher.none.fl_str_mv Sociedade Portuguesa de Nefrologia
publisher.none.fl_str_mv Sociedade Portuguesa de Nefrologia
dc.source.none.fl_str_mv Portuguese Journal of Nephrology &amp; Hypertension v.31 n.2 2017
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron_str RCAAP
institution RCAAP
reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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